PRIMEVIEW

ADHD
For the Primer, visit doi:10.1038/nrdp.2015.20

Attention-deficit/hyperactivity ADHD is a heterogeneous EPIDEMIOLOGY

MECHANISMS disorder with multiple
disorder (ADHD) is a common
neurodevelopmental disorder characterized Connections causes that probably differ
within
between individuals ADHD is strongly related to both age
by impairing symptoms of inattention and and between
Structural and functional regions and sex. Approximately 5% of children and
hyperactivity–impulsivity. ADHD can also
changes in the brain, such adolescents and 2.5% of adults are affected
often affect inhibitory control, working
as altered size, activity by ADHD. The prevalence of ADHD does
memory, planning and reward processing. and connectivity of brain not markedly differ geographically, and
regions, accompany ADHD the overall rate of ADHD in the population
White matter
Brain structure integrity has remained stable over the past 30 years.
MANAGEMENT and function Dopamine
Although individuals who experience
system
socioeconomic disadvantage are over-
Pharmacological treatments are the most effective Brain Noradrenaline represented among patients with ADHD, no
size Frontoparietal system
approach for minimizing ADHD symptoms in network direct evidence links socioeconomic status
both children and adults, and act to modulate the to the development of this disorder.
activity of neurotransmitters. Stimulants alter
Ventral Genomic
the transport of dopamine, whereas non-stimulants Serotonin variation
attention system
Frontostriatal network
either inhibit the reuptake of noradrenaline or network
stimulate the α2-adrenergic receptors. Given
that patients normally require treatments that
Visual
manage ADHD symptoms throughout the day, system
a key challenge for clinicians is to optimize
Low Pesticides
pharmacological formulations and doses to birth weight
meet the biological characteristics and social Alcohol
Genetics account
needs of each individual patient. Although less Parenting
style for ~70–80% of the In young people, ADHD is
effective for core symptoms, non-pharmacological Smoking Neurite
outgrowth risk for developing diagnosed in boys more often
treatments are often the first choice for preschool- system ADHD. Although than it is in girls (sex ratio
aged children and for targeting specific areas of the specific of ~3:1), whereas in adults it
impairment and co-morbid symptoms. sequences involved affects men and women equally
are unknown,
Environmental factors, multiple common
Premature
such as exposure in utero to birth and rare variants
certain substances, increase act together to
School or work the risk of developing ADHD Environment cause the disorder OUTLOOK

Large-scale genetic investigations, such

as genome-wide association studies and
Treatments need to QUALITY OF LIFE whole-genome sequencing studies, will be crucial
target all aspects in the mapping of the multiple biological pathways
of daily life
Individuals with ADHD are academic and occupational compared with the general that cause ADHD. With combined neuroimaging
at increased risk for a range underachievement, social population. Accordingly, these data, cell-based and animal model research
of poor social outcomes rejection by peers and family functional impairments translate and behavioural studies in humans, the future
Leisure throughout their lifetime, conflict. Patients with ADHD are to reduced quality of life as holds promise for uncovering the basis of ADHD
Home or family including addiction and also at increased risk for obesity, measured by psychological, heterogeneity — thereby improving diagnosis and
substance abuse, criminality, suicide and premature death social and health indicators. management approaches.

Designed by Laura Marshall Article number: 15027; doi:10.1038/nrdp.2015.27; published online 6 August 2015
© 2015 Macmillan Publishers Limited. All rights reserved